Map of Africa showing number of publications from countries reporting NTS blood culture isolates.

<p>Regions are indicated using coloured boundaries based on United Nations classification</p

Proportion of Community acquired blood stream infections caused by NTS in African countries (1966 to 2014)

<p>Proportion of Community acquired blood stream infections caused by NTS in African countries (1966 to 2014)</p

Published reports of iNTS disease in Africa by year of publication

<p>Published reports of iNTS disease in Africa by year of publication</p

A Systematic Review of the Incidence, Risk Factors and Case Fatality Rates of Invasive Nontyphoidal <i>Salmonella</i> (iNTS) Disease in Africa (1966 to 2014)

<div><p>This study systematically reviews the literature on the occurrence, incidence and case fatality rate (CFR) of invasive nontyphoidal <i>Salmonella</i> (iNTS) disease in Africa from 1966 to 2014. Data on the burden of iNT<i>S</i> disease in Africa are sparse and generally have not been aggregated, making it difficult to describe the epidemiology that is needed to inform the development and implementation of effective prevention and control policies. This study involved a comprehensive search of PubMed and Embase databases. It documents the geographical spread of iNTS disease over time in Africa, and describes its reported incidence, risk factors and CFR. We found that Nontyphoidal <i>Salmonella</i> (NTS) have been reported as a cause of bacteraemia in 33 out of 54 African countries, spanning the five geographical regions of Africa, and especially in sub-Saharan Africa since 1966. Our review indicates that NTS have been responsible for up to 39% of community acquired blood stream infections in sub-Saharan Africa with an average CFR of 19%. <i>Salmonella</i> Typhimurium and Enteritidis are the major serovars implicated and together have been responsible for 91%% of the cases of iNTS disease, (where serotype was determined), reported in Africa. The study confirms that iNTS disease is more prevalent amongst Human Immunodeficiency Virus (HIV)-infected individuals, infants, and young children with malaria, anaemia and malnutrition. In conclusion, iNTS disease is a substantial cause of community-acquired bacteraemia in Africa. Given the high morbidity and mortality of iNTS disease in Africa, it is important to develop effective prevention and control strategies including vaccination.</p></div

Risk factors associated with iNTS disease in Africa (1966 to 2014)

<p>Risk factors associated with iNTS disease in Africa (1966 to 2014)</p

Published reports of incidence of iNTS disease in Africa (1966 to 2014)

<p>Published reports of incidence of iNTS disease in Africa (1966 to 2014)</p

CFR of iNTS disease from studies in Africa (1966 to 2014)

<p>CFR of iNTS disease from studies in Africa (1966 to 2014)</p

Pathogens reported from community acquired bacteraemia cases in Africa (1966 to 2014)

<p>Pathogens reported from community acquired bacteraemia cases in Africa (1966 to 2014)</p

Strategy for selection of eligible articles.

<p>Adapted from the PRISMA group 2009 flow diagram [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005118#pntd.0005118.ref203" target="_blank">203</a>].</p